This section is from the book "Materia Medica And Therapeutics Inorganic Substances", by Charles D. F. Phillips. Also available from Amazon: Materia medica and therapeutics.
There are two varieties of indigestion in which hydrochloric acid is especially indicated -the so-called "atonic" form, and the "acid" form - but the mode of its use is somewhat different for each.
Atonic dyspepsia occurs either in connection with general weakness or impaired hygienic conditions - for instance, in over-worked factory girls, seamstresses, etc., - or in well-fed person who tax their stomach with too much nitrogenous food while leading a sedentary life. The secretion of gastric juice is but scanty, and the patient suffers from weight and heaviness after food, from general oppression, and other signs of unfinished digestion. One indication for the treatment of such a condition is to supply additional acid to the gastric secretion; but, as we have reason to believe that adding such acid before a meal will check the formation of the naturally acid though scanty gastric juice, it is better to allow this to do what it can, and to prescribe our medicinal acid shortly after food has been taken, with the object of assisting nature, and not interfering unduly.1
In cases of "acid" dyspepsia, the patient suffers rather from heartburn and regurgitation of sour fluid, connected either with hyper-secretion from the gastric glands, or abnormal fermentation of starchy, saccharine, or fatty food. It is true that the symptoms may often be relieved by soda, but in many cases, more permanent relief will be given by dilute hydrochloric acid administered about half an hour before a meal. This will lessen the amount of the natural secretion, and will check fermentation.
It is only recently that this important distinction as to the time of taking an acid with reference to food has been recognized; many writers, Nothnagel for instance, are satisfied with recommending its use always before meals, and certainly if it be given after food, in cases of pyrosis or water-brash, it will aggravate the mischief; these are the true cases in which its use is indicated before meals, when it exerts an astringent ac- tion. It is contra-indicated in acute inflammatory, and also in organic disease; and in any case its use should not be continued too long, or the digestive property of the gastric juice will be impaired.
Headache, especially felt in the temple and brow, and marked giddiness are often connected with the dyspepsia above described, and are relieved by hydrochloric acid.
In dyspepsia or "apepsia," connected with deficient action of the intestinal glands, and accompanied with a chronic looseness of the bowels, the acid has given very good results, used in the manner directed under hydrochloric acid.
Dr. Elliotson, in a special treatise on the subject, makes several groups of cases in which he found prussic acid extremely useful; some were marked by pain and tenderness only, others by flatulence, nausea, anorexia, liver-troubles, and vertigo, others again by pyrosis, heartburn, and palpitation (Medico-Chirurgical Review, i., 1821). A. T. Thompson made somewhat similar observations, especially noting benefit when the tongue was hot, red, and sore (Dispensatory). Bailey also published illustrative cases (London Medical Repository, 1828), and alluded to its value when there was sympathetic heart-disturbance, palpitation, etc. In such cases, it is still in frequent use, although other remedies may be required if there be marked symptoms of unhealthy secretion. Disappointment as to its effects may be sometimes traced to the inertness from age of the preparation, or to admixture with other drugs.
In many cases even of irritative dyspepsia, when the tongue is furred, with red edges and tips, and there is pain after food and heartburn, and tendency to diarrhoea after eating, I have had ample experience of the value of Fowler's solution given in 2 or 3-min. doses after meals. Dr. Thorowgood finds that it acts best when the attack seems localized in the stomach, and is independent, e.g., of hepatic congestion (Practitioner, 1870). Dr. Anstie, whose first published observations were directed to the value of arsenic in gastralgia, previously mentioned to me its equal efficacy in the dyspeptic conditions described.
Dr. Bartholow is also one of the most decided of modern writers in recommending small doses (1/20 gr.) of the double chloride for "nervous dyspepsia," as "indicated by a red glazed tongue, epigastric pain, increased after food, and tendency to relaxation of the bowels: also in duodenal and biliary catarrh, and jaundice." Vertigo and vertiginous sensations, connected with stomach disorder, are often relieved by small doses of gold chlorides, but plethora and increased intracranial blood-pressure contra-indicate their use. On the other hand, they do good in cerebral anaemia, so that they may be prescribed when bromides would not be suitable. Melancholia and hypochondriasis with depression are often connected with gastric disorder and with cerebral anaemia, and are susceptible, to some extent, of relief by the same remedy.